Fibromyalgia and Opiates for pain: Helpful or hindering?

There has been a study published in the Journal of Pain from Australia that might suggest opiates may cause increased sensitivity in some types of pain.  The study had the patients who have chronic pain and hyperalgesia, which is that intense response to pain, we also see in fibromyalgia.  They were taking methadone and morphine for the study.

Hyperalgesia is an increased pain response such that more pain is felt than dictated by the stimulus or injury would suggest.  It can be specific to an area of the body or widespread.  It can be seen with some inflammatory conditions, with some nerve damage situations and it is also a main feature of fibromyalgia.  It is quite commonly associated with long-term use of opiate medications so it is not surprising this study likewise had similar results.

“A second finding showed that similar nociceptive profiles are found in chronic pain patients treated with methadone. Third, the study showed that pain sensitivity associated with methadone administration also is found in morphine-treated patients. According to the authors, the study demonstrated that hyperalgesia but not allodynia is associated with the long-term administration of opioids.”

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In many cases, opiate based medications, such as Percocet (oxycodone) are not as effective for people with fibromyalgia and a more effective treatment are the medications acting on the brain neurotransmitters themselves.  Lyrica and Gabapentin are anticonvulsants which by affecting certain neurotransmitters try to dampen the pain signals and decrease pain where it is in fact starting.  Fibromyalgia is brain pain and medications that focus on the brain have a better chance of treating that pain.  Other medications that aim specifically at FM are Cymbalta and Savella which are antidepressants used to affect the serotonin neurotransmitter, often found to be lower in FM patients.  However, some people do take them for pain management so this will be a concern if it, in fact, increases their sensitivity to pain over time.  In the cases, where pain medications are used it might be something to be used in moderation and careful consideration.

It should be noted this risk factor occurs with all chronic pain and is a low risk. When it occurs the patient is switched to another opiate. It should also be noted Tramadol is in the guidelines for treatment as it is one that has been studied as effective for fibromyalgia pain.

This is a reprint of the study I had published on a site that is gone, so putting it up again. As I said, this is a risk factor for all people using opiates. It does run the risk of causing hyperalgesia and this study doesn’t indicate if the risk is greater with FM. However, my previous research into this effect suggests it isn’t a common reaction at all. Typically the patient is simply switched medication. There have been little studies on FM and opiates and the studies Minimal to make any conclusions about. Mostly on Tramadol, which is seen as acceptable and is in the guidelines for treatment.

Here’s the problem with this type of blanket statements: these recommendations are based on the results of only a few small studies showing they were ineffective for fibromyalgia pain. Since no large trials have been done, the recommendations against opiate use for fibromyalgia are based on data from less than 100 subjects! Also, these small studies only looked at patients taking opiates every day for pain, and we know that daily, long term use of opiates does result in negative side effects and diminishing medication benefit over time. None of these small studies assessed the most successful use of pain medications, which is when they are taken just as needed for flares.

So take it with a grain of salt. But know doctors will resist the idea based on these very little studies.

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